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Purpose: Heat intolerance (HI) is determined in the Israel Defense Force according to a heat tolerance test (HTT) before returning to duty after an exertional heat stroke (EHS) event. Recently, increased numbers of female combatants resulted in an increased number of EHS cases among women and a higher percentage of heat intolerance (HI) individuals. We aimed to evaluate the differences between tolerance to heat among women performing an HTT in relation to their menstrual cycle phase. Method: Thirty-three female participants were sorted into two groups: HI and heat tolerant (HT) according to two HTTs performed during both the luteal and follicular phases of the menstrual cycle or while consuming and during a break from consuming contraceptives. Results: HT women had an 18% higher maximal oxygen uptake (p < 0.005, 95% CI [2.6,9.8]) and 1.2% lower skin temperature in the HTT at the during and follicular phases (p < 0.01, 95% CI [0.12,0.77]) and 1.7% lower at the off and luteal phases (p < 0.001, 95% CI [0.34,0.92]). The mean sweat rate was 14% lower among the HI group only at the HTT at the during and follicular phases (p < 0.05, 95% CI (3,88)]). Conclusion: We found that HT can be predicted using aerobic capacity and core body temperature. Moreover, during the luteal phase, women presented altered thermoregulation that decreased the probability of being HT. This emphasizes the importance of considering the HT/HI criteria in the HTT for women, according to their aerobic ability and menstrual-cycle phase.

Introduction: This observational study investigated the effects of sleep deprivation and ad libitum caffeine consumption on cognitive performance, risk behavior, and mood among 28 Israeli Special Forces (SF) soldiers (mean age: 20.57 ± 0.92 years) during a 96-hour combat exercise. Methods: Actigraphy was used to monitor sleep and activity; cognitive function, risk-taking propensity, mood states, and self-reported sleepiness were assessed using the Psychomotor Vigilance Task (PVT), Evaluation of Risks Scale (EVAR), Profile of Mood States (POMS), Karolinska Sleepiness Scale (KSS); and caffeine consumption by questionnaire at 0, 50, and 96 hours. For analyses, participants were divided into Low (<400mg) and High (=400mg) caffeine consumption groups. Results: The soldiers hiked 108.5 ± 0.52 km and slept for 12.7 ± 0.5 h, with a notable transition from multiple short sleep epochs in the initial 50 hours to a consolidated 5-hour sleep period subsequently. In the High caffeine group, PVT reaction time was faster (p = 0.024) compared to the Low caffeine group, with fewer premature response errors (p = 0.026). However, this group showed increased risk-taking (p = 0.037), particularly reduced Self-Control (p = 0.010). No significant impact of ad libitum caffeine intake on mood was observed. However, degradation over the course of the exercise in both groups in mood states, including anger, fatigue, tension, and vigor, was noted (p < 0.05). KSS scores increased significantly at 50 and 96 h (p < 0.001). Discussion: These results suggest that while caffeine enhances cognitive function, its ad libitum consumption did not consistently improve these measures in this cohort of SF soldiers. The study highlights the complex relationship between sleep deprivation and caffeine intake and their combined effects on soldiers' cognitive and behavioral functions, indicating a need for evidence-based caffeine use guidelines for using caffeine in military settings. [ABSTRACT FROM AUTHOR]

Background: Current casualty care training modalities present several challenges, including limited simulation facilities, instructor dependence, lack of standardization, documentation of trainees' performance and training personalization. The study presents the design, development and preliminary evaluation of a novel hybrid training platform to address these challenges. Methods: A mixed reality platform was chosen and developed to address field operators' requirements. The platform is easy to operate and can be set up by laypeople within 20-min in multiple environments. Individual-level training documentation is generated autonomously following each session, evaluating 30 aspects of performance. From this, a unique aggregated dataset emerges as a substrate for executives' dashboards and intelligent planning of future sessions. Results: An evaluation process took part using simulator-based training in different stages along the project using a questionnaire (Likert-scale based). Fifty military physicians took part in an identical head injury scenario requiring airway management by endotracheal intubation and were immediately surveyed. Conclusion: TrauMR is an agile hybrid training that harbors the potential to address many of the emerging challenges of training for prehospital care in combat and civilian environments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exertional heatstroke affects athletes and soldiers and can lead to temporary heat intolerance. The heat tolerance test (HTT) was developed to assist in the return-to-duty decisions of military personnel. Although there are several possible causes for heat intolerance, a soldier who fails the test is prevented from returning to serve in a front-line combat unit, regardless of the underlying reason. CASE REPORT:A 19-yr-old special infantry male soldier with unremarkable medical history collapsed during an afternoon hand-tohand combat training session in the gym. The medic on site promptly initiated inefficient tap water cooling and measured a rectal temperature of 38.7 °C; he returned to duty the same evening. A few weeks later, after intensive physical training, he experienced exhaustion during a stretcher-carrying foot march. He was referred by the unit's physician, who suspected a condition of heat intolerance, to an HTT. The soldier underwent two HTT s, which were found to be positive. Consequently, he was discharged from serving in his infantry unit. No congenital or functional underlying causes could explain the diagnosis of heat intolerance. DISCUSSION: We discuss the possibility that the only explaining cause for the two positive HTT s was the soldier's anthropometric measures, particularly the low body surface area to body weight ratio. We raise the question of whether this soldier could have been returned safely to duty. [ABSTRACT FROM AUTHOR]

Summary This is the first study to provide valuable insights into the effects of the Israeli Navy's 20‐h rotating watch schedule on submariners’ alertness, mood states, risk‐taking behaviours, and sleep. Specifically, we assessed the impact of the non‐circadian‐aligned schedule on cognitive performance, mood, and behavioural outcomes in a highly controlled submarine environment. A total of 20 male submariners participated in an at‐sea mission, where their cognitive performance, mood states, risk‐taking propensity, and caffeine consumption were measured. A psychomotor vigilance task (PVT) assessed alertness, the propensity for risky behaviour (Evaluation of Risks Scale) measured risk‐taking behaviours, and the Profile of Mood States evaluated mood disturbances. Actigraphy was used to monitor sleep times. Data were analysed according to seven watch schedule segments. Submariners slept a mean (standard error of the mean [SEM]) of 8.3 (0.2) h/24 h, fragmented into 3.7 (0.8) h epochs. Caffeine consumption decreased at sea (mean [SEM] 149.3 [6.0] mg) compared to land (mean [SEM] 205.5 [7.2] mg; p = 0.027). In the PVT, premature responses significantly increased during Watch VI (5:00–8:00 p.m.) and Watch VII (8:00 p.m.–12:00 a.m.; p = 0.014). In the mood subscales, tension was significantly higher during Watch II (4:00–8:00 a.m.; p = 0.002), indicating greater stress. Risk‐taking propensity significantly increased during afternoon shifts (p = 0.050). The 20‐h watch schedule led to fragmented sleep, reduced alertness in the evening, worsened mood states in the early morning, and increased risk‐taking propensity in the afternoon. These findings suggest the need for the Israeli Navy to establish evidence‐based caffeine guidelines and optimise the watch schedule to improve submariners’ sleep, performance, and overall well‐being. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak required prompt actions by health authorities around the world, in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive level decision makers with the most actionable, pertinent and updated data analysis to enable them to adapt their strategy swiftly and competently.Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Force (IDF) with the assembly of an operational Data Center for the Campaign against Coronavirus (ID3C).Methods: Spearheaded by directors with clinical, operational and data analytics orientation a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information for on an individual-level in the context of SARS-CoV2 contraction and infection.Results: Nearly 300,000 responses for daily questionnaires were recorded and were merged with other datasets to form unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data-science application we provided commanders and clinicians with access to trusted, accurate and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease, resulted in a 30% decline of their attendance to their units. Moreover, the Corona lab exams queue was optimized by using a predictive model resulted in a high true positive rate of 20%, which is more than twice as high as the baseline rate (2.28 with 95% CI of 1.63-3.19).Conclusions: In times of ambiguity and uncertainty mixed with unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data, a key factor in providing executives relevant and actionable support for decision making.Clinicaltrial: [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the significance of body surface area-to-mass ratio (BSA/mass) on the heat-tolerance test (HTT) results. We hypothesized that individuals defined as heat tolerant (HT) would have on average higher BSA/mass compared to heat intolerant (HI) individuals., Methods: A retrospective reanalysis of the HTT results of 517 soldiers (age: 18-38 yrs., M/F: 96/4%), who were tested by the Israel Defense Forces (IDF) HTT protocol. The criterion for heat tolerance in the current analysis was a rectal temperature (Tre) plateau during the second hour of the test. A logistic regression analysis to evaluate the predictive power of BSA/mass for heat intolerance was performed; the spline model was applied to show the odds for heat intolerance across BSA/mass., Results: In men BSA/mass of HI individuals was lower than HT individuals (248 ± 19 vs. 262 ± 18 cm2/kg, p < 0.01, d = 0.76). In women a similar trend was noted but with no statistical significance between HT and HI groups. The odd ratio for heat intolerance for every unit increase in BSA/mass was 0.97 (CI 95% 0.95-0.99). The spline model plateaued above BSA/mass of 270 cm2/kg., Conclusions: The results imply that body-core temperature responses to a standard exercise-heat stress (fixed external work rate and climatic conditions) are influenced by BSA/mass. More specifically, lack of a steady state in Tre (indicating heat intolerance) was more likely to occur with every unit decrease in BSA/mass. These findings contribute to a better understanding of the role of body anthropometry in the response to a standard exercise-heat task that might have an implication on clinical decision-making about return to duty/play of soldiers, athletes and others who deemed to be identified as HI., Competing Interests: Conflict of Interest and Funding Source: This study has no funding sources. No conflicts of interest, financial or otherwise, are declared by the authors. N. C. is an employee of the Department of the Army of the United States., (Copyright © 2024 by the American College of Sports Medicine.)

Background: The COVID-19 outbreak required prompt action by health authorities around the world in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive-level decision-makers with the most actionable, pertinent, and updated data analysis to enable them to adapt their strategy swiftly and competently., Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Forces with the assembly of an operational Data Center for the Campaign against Coronavirus., Methods: Spearheaded by directors with clinical, operational, and data analytics orientation, a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information on an individual level in the context of SARS-CoV-2 contraction and infection., Results: Nearly 300,000 responses to daily questionnaires were recorded and were merged with other data sets to form a unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data science application, we provided commanders and clinicians with access to trusted, accurate, and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease and resulted in a 30% decline in their attendance to their units. Moreover, the queue for laboratory examination for COVID-19 was optimized using a predictive model and resulted in a high true-positive rate of 20%, which is more than twice as high as the baseline rate (2.28%, 95% CI 1.63%-3.19%)., Conclusions: In times of ambiguity and uncertainty, along with an unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data a key factor in providing executives relevant and actionable support for decision-making., (©Gil A Geva, Itay Ketko, Maya Nitecki, Shoham Simon, Barr Inbar, Itay Toledo, Michael Shapiro, Barak Vaturi, Yoni Votta, Daniel Filler, Roey Yosef, Sagi A Shpitzer, Nabil Hir, Michal Peri Markovich, Shachar Shapira, Noam Fink, Elon Glasberg, Ariel Furer. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.09.2021.)

Introduction: The coronavirus disease 2019 (COVID-19) outbreak has resulted in considerable morbidity and mortality, and caused comprehensive social and financial damages. Anatomical, physiological and occupational differences observed between men and women might influence the reaction to treatment and medications. This article reviews sex differences and their potential effect on COVID-19 infection, pathogenesis and prognosis in women compared to men.